Nokea
Dohle bodies are patches of dilated endoplasmic reticulum that appear as cerulean blue cytoplasmic puddles. These findings are mostly seen in
- A. Chronic myeloid leukemia
- B. Leukemoid reaction
- C. Chediak-Higashi syndrome
- D. Infectious mononucleosis
Correct Answer: D
Rationale: The correct answer is D: Infectious mononucleosis. Dohle bodies are seen in infectious mononucleosis due to the accumulation of rough endoplasmic reticulum in neutrophils. This is a result of the viral infection causing stress on the neutrophils. In chronic myeloid leukemia (A), leukemoid reaction (B), and Chediak-Higashi syndrome (C), Dohle bodies are not typically observed. In chronic myeloid leukemia, the characteristic finding is the Philadelphia chromosome. Leukemoid reaction is a reactive increase in white blood cells due to infection or inflammation. Chediak-Higashi syndrome is a rare autosomal recessive disorder characterized by defective phagolysosome formation.
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A 2-month-old infant is brought to your clinic with an extensive scaly rash on the scalp, which has been biopsied and shown to be Langerhans cell histiocytosis (LCH). You want to determine whether this patient has skin-only LCH or involvement of any of the 'high-risk' organs. The child has a normal CBC; normal liver enzymes and bilirubin; and a normal skeletal survey, skull films, and chest X ray. What other screening test will be important for finding involvement of a high-risk organ?
- A. Reticulocyte count
- B. Erythrocyte sedimentation rate
- C. Alkaline phosphatase
- D. Serum albumin and total protein
Correct Answer: D
Rationale: The correct answer is D: Serum albumin and total protein. In Langerhans cell histiocytosis (LCH), involvement of high-risk organs like the liver, spleen, and bone marrow can occur. Serum albumin and total protein levels can indicate liver involvement as hypoalbuminemia and hypoproteinemia can be seen in liver dysfunction. The other choices, A (Reticulocyte count), B (Erythrocyte sedimentation rate), and C (Alkaline phosphatase) are not specific for evaluating high-risk organ involvement in LCH. Reticulocyte count is related to red blood cell production, ESR is a nonspecific marker of inflammation, and alkaline phosphatase is commonly elevated in various conditions, not specific for high-risk organ involvement in LCH.
A nurse is preparing to assist with a bone marrow biopsy. Which anatomical site should the nurse anticipate will be used to obtain the specimen?
- A. Ribs
- B. Humerus
- C. Posterior iliac crest
- D. Long bones in the legs
Correct Answer: C
Rationale: The correct answer is C: Posterior iliac crest. This site is commonly used for bone marrow biopsies due to its accessibility and abundance of red bone marrow. The iliac crest is a flat bone, making it easier to access for the procedure compared to the round shape of other bones listed. Ribs (A) are not commonly used due to the risk of pneumothorax. The humerus (B) is not an ideal site as it contains mostly yellow bone marrow. Long bones in the legs (D) are not typically used for bone marrow biopsies due to the difficulty in accessing and the higher risk of complications.
When assessing a newly admitted patient, the nurse notes pallor of the skin and nail beds. The nurse should ensure that which laboratory test has been ordered?
- A. Platelet count
- B. Neutrophil count
- C. White blood cell count
- D. Hemoglobin (Hgb) level
Correct Answer: D
Rationale: The correct answer is D: Hemoglobin (Hgb) level. Pallor of the skin and nail beds indicates possible anemia, which is a decrease in red blood cells or hemoglobin. Checking the hemoglobin level will confirm if the patient is anemic. Platelet count (A) assesses for clotting ability, not anemia. Neutrophil count (B) and White blood cell count (C) are indicators of infection or inflammation, not anemia. Therefore, ensuring the hemoglobin level has been ordered is crucial for assessing the patient's pallor.
The typical Reed-Sternberg cells are either infrequent or absent. Instead, lymphocytic and histiocytic cells or 'popcorn cells' are seen within a background of inflammatory cells, which are predominantly benign lymphocytes. Which type of Hodgkin's lymphoma best suit the description?
- A. Nodular sclerosis
- B. Mixed cellularity
- C. Lymphocyte depleted
- D. Lymphocyte predominance
Correct Answer: D
Rationale: The correct answer is D: Lymphocyte predominance. In this type of Hodgkin's lymphoma, the typical Reed-Sternberg cells are absent or rare. Instead, popcorn cells (lymphocytic and histiocytic cells) are seen among benign lymphocytes. This is characteristic of lymphocyte predominance subtype.
A: Nodular sclerosis - characterized by lacunar Reed-Sternberg cells in a background of collagen bands.
B: Mixed cellularity - characterized by numerous Reed-Sternberg cells, eosinophils, plasma cells, and histiocytes in a background of mixed inflammatory cells.
C: Lymphocyte depleted - characterized by few Reed-Sternberg cells in a background of fibrosis and few inflammatory cells.
Therefore, based on the description provided, choice D is the most appropriate answer.
A nurse is caring for a client who has renal failure and is receiving epoetin. The nurse should monitor the client for which of the following adverse effects?
- A. Hypertension
- B. Muscle pain
- C. Edema
- D. Dry mouth
Correct Answer: A
Rationale: The correct answer is A: Hypertension. Epoetin stimulates red blood cell production, increasing blood volume and potentially leading to hypertension. This adverse effect is known as hypertensive crisis. Muscle pain (B), edema (C), and dry mouth (D) are not typically associated with epoetin therapy for renal failure. Thus, they are incorrect choices.